Optimizing influenza vaccine distribution

The recent emergence of the influenza strain (the "swine flu") and delays in production of vaccine against it illustrate the importance of optimizing vaccine allocation. Using an age-dependent model parametrized with data from the 1957 and 1918 influenza pandemics, which had dramatically different mortality patterns, we determined optimal vaccination strategies with regard to five outcome measures: deaths, infections, years of life lost, contingent valuation and economic costs. In general, there is a balance between vaccinating children who transmit most and older individuals at greatest risk of mortality, however, we found that when at least a moderate amount of an effective vaccine is available supply, all outcome measures prioritized vaccinating schoolchildren. This is vaccinating those most responsible for transmission to indirectly protect those most at risk of mortality and other disease complications. When vaccine availability or effectiveness is reduced, the balance is shifted toward prioritizing those at greatest risk for some outcome measures. The amount of vaccine needed for vaccinating schoolchildren to be optimal depends on the general transmissibility of the influenza strain (R_0). We also compared the previous and new recommendations of the CDC and its Advisory Committee on Immunization Practices are below optimum for all outcome measures. In addition, I will discuss some recent results using mortality and hospitalization data from the novel H1N1 "swine flu" and implications of the delay in vaccine availability.